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Reduced peanut sensitization with maternal peanut consumption and early peanut introduction while breastfeeding
Meghan B Azad1,2,3, Christoffer Dharma4, Elinor Simons1,2
1Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
Insights
Introducing peanut early in infancy, especially while breastfeeding and with maternal peanut consumption, significantly reduces allergy risk. This "triple exposure" may offer optimal protection against peanut sensitization.
Area of Science:
- Allergy and Immunology
- Pediatric Nutrition
- Epidemiology
Background:
- Current infant peanut allergy prevention guidelines recommend early introduction but lack guidance on breastfeeding and maternal diet.
- The CHILD birth cohort study investigates factors beyond infant-led introduction for peanut sensitization.
Purpose of the Study:
- To assess the independent and combined effects of maternal peanut consumption, breastfeeding, and infant peanut introduction timing on peanut sensitization.
- To explore the association of these factors with the development and resolution of peanut sensitization.
Main Methods:
- Analysis of data from 2759 mother-child dyads in the CHILD birth cohort.
- Mothers reported on peanut consumption during pregnancy, infant feeding practices, and breastfeeding duration.
- Child peanut sensitization assessed via skin prick testing at ages 1, 3, and 5 years.
Main Results:
- Early infant peanut introduction (before 1 year) after breastfeeding cessation reduced sensitization risk by 66%.
- This risk reduction was further enhanced by early introduction during breastfeeding and concurrent maternal peanut consumption (0.3% sensitization).
- Maternal peanut consumption alone showed no significant benefit or harm without breastfeeding.
Conclusions:
- A combination of maternal peanut consumption, breastfeeding, and early infant peanut introduction may significantly decrease peanut allergy sensitization risk.
- These findings suggest a potential
- triple exposure
- protective effect that warrants further investigation.
- Mechanistic and clinical studies are needed to confirm and elucidate the
- triple exposure
- hypothesis in peanut allergy prevention.
Abstract:
New guidelines for peanut allergy prevention in high-risk infants recommend introducing peanut during infancy but do not address breastfeeding or maternal peanut consumption. We assessed the independent and combined association of these factors with peanut sensitization in the general population CHILD birth cohort (N = 2759 mother-child dyads). Mothers reported peanut consumption during pregnancy, timing of first infant peanut consumption, and length of breastfeeding duration. Child peanut sensitization was determined by skin prick testing at 1, 3, and 5 years. Overall, 69% of mothers regularly consumed peanuts and 36% of infants were fed peanut in the first year (20% while breastfeeding and 16% after breastfeeding cessation). Infants who were introduced to peanut early (before 1 year) after breastfeeding cessation had a 66% reduced risk of sensitization at 5 years compared to those who were not (1.9% vs. 5.8% sensitization; aOR 0.34, 95% CI 0.14-0.68). This risk was further reduced if mothers introduced peanut early while breastfeeding and regularly consumed peanut themselves (0.3% sensitization; aOR 0.07, 0.01-0.25). In longitudinal analyses, these associations were driven by a higher odds of outgrowing early sensitization and a lower odds of late-onset sensitization. There was no apparent benefit (or harm) from maternal peanut consumption without breastfeeding. Taken together, these results suggest the combination of maternal peanut consumption and breastfeeding at the time of peanut introduction during infancy may help to decrease the risk of peanut sensitization. Mechanistic and clinical intervention studies are needed to confirm and understand this "triple exposure" hypothesis.
